Preferred Provider Organization | Health Insurance Blog

January 4, 2011

Types of Health Insurance Plans

Filed under: Health Insurance — Tags: Fee-for-Service, Health Maintenance Organizations, indemnity plans, insurance agency, medical insurance coverage, Point of Service Plans, Preferred Provider Organization, primary health care provider, types of plans — admin @ 3:24 pm

Whatever may be the reason to visit the hospital, it often turns costly. So, world over, the common practice is to get into a medical insurance coverage for getting over the costly health care bills in such situations. There are different types of schemes to get into and the coverage style also varies. So it is better to have a basic knowledge of the different types of plans available before deciding upon a plan that seems perfect for a person.

Generally there are 4 types of plans which the insurance agencies provide.

The first of these is the Health Maintenance Organizations (HMO). In this type of plan one pays for the coverage in advance and does not have to pay for each health service activities separately. The premiums are generally of monthly nature and the range of benefits includes preventive care, dental care, care for vision, etc. The health service providers are generally employees of the organization and will act as what is known as ‘primary care giver’. They will be responsible for coordinating the health care operations and generally need a co-payment option for hospital stay specialist visit, and the like of it.
The next type of plan is Point of Service Plans. The POS plans do not need one to get referrals from the primary care giver for any medical needs. Instead there are three options. One can still get referral from the primary health care provider and then get under HMO plan; or, one can avail care through the Preferred Provider Organization and get coverage under their terms and conditions; or, choose for care options outside these two and get benefits on out-of network rules.
The third type is the Preferred Provider Organization or PPO where the insurance agency offers an assortment of doctors and medical and health care facilities for treatment under their network. One has the flexibility of opting for treatment outside their network subject to ‘out-of-network’ rules.
The last type is the Fee-for-Service or Indemnity plans. This is the traditional service plan that has a fixed deductible coverage which reimburses the cost of treatment within that amount. This is the most flexible of the plans and allows choosing a physician and medical care provider at one’s wish.

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December 26, 2010

HMO vs PPO Health Insurance Plans

Filed under: Health Insurance — Tags: health care insurance, Health Maintenance Organization, HMO plan, medical insurance, PPO plan, Preferred Provider Organization — admin @ 2:48 pm

People generally get medical insurance under managed care plans. They either come under the HMO plan or the PPO plan. There are some basic differences between the two and people often fail to choose the right one suitable for them as they are most of the time ill informed about the benefits of the two.

In HMO or Health Maintenance Organization plans one pays a monthly fee to the organization in exchange for treatment at a reduced rate. The HMOs have a group of enlisted health care providers where the insured will have to go to get the facility of insurance. No deductible is needed for this facility. But in the PPO or Preferred Provider Organization type of plans have a group of health care providers coming into an agreement with the insurer or a third-party administrator to provide health care service to the insured at a reduced rate.

The basic advantage of HMO plans over all other types of plans is that they are the cheapest form of health care insurance that a person can get. The system can last a lifetime as long as one stays a member of the scheme. Another advantage is that one needs no amount of deductible to be built up before the insurer starts providing the service. The amount of co-payment is also very low and one can easily visit the primary care provider at the early stage and thus going for a preventive approach rather than a costly corrective approach to a disease.

The downside is that one can only get health care from the enlisted primary care givers. Referral to the specialists needs to be made by this primary care giver. So there one loses one’s flexibility of choosing the preferred specialist.

There PPO scores over the HMO plans because in the PPO plans one is free to choose or select the physician or specialist of one’s choice. He may even be outside the PPO network. But such facilities are to be met from the annual deductible that one has to maintain by the way of paying premiums. No reimbursement will be met outside this deductible. Moreover, for claim of the amount one will have to go through a tedious process of filling up forms and reconciling the bills with the insurance payment statements.

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